N448Remark Code (RARC)Active
N448 Remark Code - Not Included in Fee Schedule
The N448 remark code indicates that a specific drug, service, or supply is not covered under the payer's fee schedule or is excluded from any contracted or legislated fee arrangement. This means that the billed item is not eligible for reimbursement based on the payer's established policies.
How It Relates to the Denial
The N448 remark typically accompanies a Claim Adjustment Reason Code that indicates a denial or reduction in payment due to the service or item not being included in the payer's fee schedule. Together, they signal that the service billed cannot be reimbursed due to its exclusion from coverage.
Common Scenarios
1A provider submits a claim for a newly approved medication that is not listed in the payer's formulary. The remittance shows the N448 remark alongside a reason code indicating a denial of payment.
→ The N448 remark clarifies that the medication is not part of the payer's fee schedule, which means it won't be reimbursed.
2An outpatient facility bills for a special supply used during a procedure. The claim is returned with a reduction in payment and the N448 remark present.
→ The N448 remark suggests that the supply is not covered under the facility's contract with the payer, leading to the payment reduction.
3A claim is submitted for a service that is typically covered, but the specific instance involves an experimental treatment. The payer responds with an adjustment and includes the N448 remark.
→ This remark indicates that the experimental treatment is excluded from the fee schedule, thus the payer will not reimburse for this service.
What to Do
- Review the claim to confirm the drug, service, or supply billed and its coverage status with the payer.
- Consider alternative billing options if the item is critical for patient care and not covered under the current payer's policy.
- If applicable, discuss with the provider the possibility of obtaining prior authorization for future claims involving similar items.
What to Check
- The payer's fee schedule to determine if the billed item is listed or excluded.
- Any contract agreements with the payer that outline covered services and supplies.
- The patient’s benefit plan document for coverage details regarding the specific drug, service, or supply.